Underage drinking is most commonly understood to be illegal drinking by youth who are below the minimum legal age at which a person may purchase beverage alcohol in any given jurisdiction. For example, in many countries around the world, the legal drinking age is 18-years old (including Australia, China, Mexico, Poland, Russia, and South Africa). In Japan, the legal drinking age is 20-years old, and in the United States, the legal drinking age is 21. (For more information on legislated drinking age limits, see Appendix I.)
Also, for the purposes of this discussion, the concept of underage drinking is understood to preclude religious occasions and ceremonies which may traditionally involve beverage alcohol, as well as parental serving of alcohol to their children in the home. (For similar and additional related content, see The Issues Forum entry on Legal Drinking Age.)
BACKGROUND AND THE ISSUE
Drinking by youth under the legal drinking age is a matter of public health concern internationally. Every year in the United States alone, about 5,000 youth under age 21 die from motor vehicle crashes, other unintentional injuries, and homicides and suicides that involve underage drinking.i Heavy episodic (or “binge”) drinking patterns of certain underage youth are of particular concern and have been the focus of greater attention in recent years. (For more on related topics, see The Issues Forum entries addressing Drunk Driving and Binge Drinking.)
In addition, it is generally accepted that underage youth are at increased risk for certain harmful drinking behaviors and negative consequences. As summarized by the executive committee issuing a National Academy of Sciences report on underage drinking:
Alcohol use by young people is dangerous, not only because of the risks associated with acute impairment, but also because of the threat to their long-term development and well being. Traffic crashes are perhaps the most visible of these dangers, with alcohol being implicated in nearly one-third of youth traffic fatalities. Underage alcohol use is also associated with violence, suicide, educational failure, and other problem behaviors.ii
Emerging research on the potential negative effects of alcohol on the growth and development of adolescent brains is also cause for concern. There is also research which illuminates the key role of genetics in how alcohol affects brain function, and why the effects may be more severe in some individuals than others.iii In addition, research shows that children who begin to consume alcohol before age 15 are five times more likely to have alcohol-related problems than those who started drinking after age 21.iv
i National Institute on Alcohol Abuse and Alcoholism, Underage Drinking Research Initiative. See http://www.niaaa.nih.gov/aboutNIAAA/NIAAASponsoredPrograms/underage.htm.
ii National Research Council and Institute of Medicine (2003). Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to reduce and Prevent Underage Drinking, Richard J. Bonnie and Mary Ellen O’Connell, editors. Executive Summary, p.1.
iii See: http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm.
ivSee: http://www.apha.org/NR/rdonlyres/FCFEC446-838F-461F-A111-5A284E7566AC/0/A12004.pdf. See also: http://www.adcouncil.org/default.aspx?id=263, citing U.S. federal agency sources. See also: Alcohol risks greater in teen-onset drinkers, Pediatrics (June 5 2009) at http://pediatrics.aappublications.org/cgi/search?fulltext=hingson&volume=123&issue=6.
Findings on Underage Drinking
Drinking by underage youth is generally considered illegal in most countries and societies. That said, it is also true that at least limited experiences with alcohol are reported by young people and their families around the world. In some societies, young people may be introduced to alcohol at younger ages than in others—typically in the context of family meals or celebrations.i
Research shows that underage males are more likely to drink than underage females, and also more likely to do so in higher quantities (although some recent studies also show a narrowing of this gender differential).ii In addition, a society’s overall drinking culture has been shown to be a consistently influential factor in determining whether or how young people drink. For instance, in countries such as Greece and Italy with the so-called “Mediterranean” approach to drinking, young people have been found to be more likely to drink, and to drink more often, than their counterparts in other regions, yet also less likely to drink to the point of drunkenness or to display other problematic behaviors associated with excessive drinking. Young people in Scandinavia, on the other hand, have been found to be more likely to drink in a problematic and risky manner.iii, iv, v
In the United States, according to the U.S. Surgeon General, by age 15, approximately 50 percent of boys and girls have had a whole drink of alcohol; by age 21, approximately 90 percent have done so.vi
Also in the U.S., the annual Monitoring the Future survey results issued by the National Institute on Drug Abuse reflect that in 2009, the percentage of underage youth who admitted drinking an alcohol beverage in the prior 30-day period were represented as follows:
In addition, the National Survey on Drug Use and Health (NSDUH) issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. reports that more than one quarter (28.1 percent) of people aged 12 to 20 consumed alcohol in the past month—including:
51.1 percent of those aged 18 to 20,
25.9 percent of those aged 15 to 17, and
6.1 percent of those aged 12 to 14.viii
There is also research which shows that although adolescents drink less frequently than adults, when they do drink, they drink more heavily than adults.ix In addition, some studies have shown that early initiation of alcohol consumption is associated with higher likelihood of involvement in risky behaviors including driving after drinking, riding with a driver who has been drinking, sexual activity and pregnancy, and interpersonal violence.x, xi
How Underage Youth Make Their Decisions about Whether or Not to Drink
Although there are legal drinking age laws around the world, most young people have some experience with beverage alcohol before they reach the legal drinking age. In addition to culture, other factors have been found to be key influences in shaping young people’s attitudes and approaches toward consuming alcohol. Research also consistently confirms the central role played by parents in influencing their children’s attitudes and behaviors with regard to drinking. According to the 2008 Roper Youth Report, of the individuals between the ages of 8 and 17 surveyed in the U.S., 71 percent identified their parents as the leading influence that might affect their decisions about drinking.xii
In addition, research surveys reflect that friends and peers play a role in whether young people decide to drink—and if they do decide to drink, their drinking behaviors.xiii, xiv In addition, certain studies have found that young people involved in organized extracurricular activities are less likely to drink in ways that result in negative consequences.xv However, there are studies which also indicate that young people involved in athletic activities are sometimes more likely to engage in dangerous drinking behaviors.xvi
Table 1 Youth Survey
Drinking deisions: what youth say...
Among six things that might affect their decisions about drinking. 71% of American Youth (age 13-17) identified their parents as the leading influence.
Source: GfK Roper YOuth Report. This report was developed from an online survey of 1,008 Americans age 8-17, conducted online March 19, 2008 - April 27, 2008; the data are weighted based on online population estimates from MediaMark‘s (MRI) American Kids and Teens Survey.
*Media includes TV, radio magazines and internet.
In 2008 the respondents could only choose one answer option fo rthis question.
Q.A11: Many times we get ideas for things from what other people say and do. I am going to read a list of some different things and ask which people or things, beside yourself, have influenced you the most in that particular area...wherther you drink alcohol or not.
Young Peoples’ Drinking Behaviors and Patterns
Parental influence and drinking habits have been found to play a very significant role in shaping the drinking behaviors of adolescents and young adults—both positively and negatively.xvii, xviii For instance, one recent study found that even many young children are introduced to alcohol by tasting and sipping in the home—as opposed to having a full drink—most often in a family or religious context, and almost never with friends or when alone. The study reported that in the scientific sample of 452 children aged 8 to 10 interviewed (along with their parents), nearly 40 percent had sipped or tasted alcohol, whereas only six percent had ever had an actual drink.xix The significant role of parents—and parents’ drinking habits—in influencing how their children drink is emphasized in initiatives such as those developed by DrinkWise and its “Kids Absorb Your Drinking” campaign (see www.drinkwise.com.au), as well as Ireland’s “Is your drinking affecting your thinking” initiative (www.meas.ie).
Family structure can also factor into the development of drinking patterns. For instance, adolescents who have a close relationship with their parents and enjoy a strong sense of family support are reported to be less likely to experience problems associated with drinking than those who lack close family ties and/or adult guidance and supervision.xx
How Underage Youth Obtain Alcohol
In a June 2008 SAMHSA study, survey results showed than more than 40 percent of underage drinkers in the U.S. were given alcohol for free by an adult age 21 or older. More than half said that they were at someone else’s home when they had their last drink, and more than 30 percent were in their own home.xxi According to the latest NSDUH report in the U.S., about one in four (26.4 percent) people aged 12 to 20 reported getting alcohol for free from a non-relative of legal drinking age. In addition, 14.6 percent reported getting alcohol for free from an underage peer. Parents and other relatives also play a role in giving alcohol to underage youth, with 8.5 percent reporting that they received alcohol from a relative of legal drinking age, and 5.9 percent receiving it from a parent or guardian.xxii
A recent survey commissioned by The Century Council asked teens, 'Where do you get the alcohol that you drink?' Sixty-five percent of the underage youth surveyed said that they got the alcohol they drink from family and friends, meaning they got it from their parents, their friends' parents, older siblings or family members or older friends, with or without permission.
Payment or receipt of alcholol for free for the last use in the past month among alcohol users aged 12 to 20, 2006 & 2007
[anual average percentage, by age group & gender]
The relationship between marketing, advertising, and alcohol consumption has been studied using a variety of methodologies. The balance of the evidence does not show a causal relationship between overall alcohol marketing and drinking levels or harmful drinking patterns.xxiii According to the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA), “When all of the studies are considered, the results of research on the effects of alcohol advertising are mixed and not conclusive.”xxiv
On the one hand, there is research which shows that parents, and to some extent peers—not advertisements—are the most powerful factor in young peoples’ decisions to drink (and if they do drink, how and to what extent). Moreover, the research tends to show that advertising by alcohol producers largely affects market share for particular brands and substitution between brands. In other words, advertising has not been shown to increase consumption levels, either amongst adults or youth—but rather, has a documented impact on the extent to which certain products and brands are preferred and consumed, versus other products and brands.xxv
On the other hand, there are recent longitudinal studies which show a modest correlation between advertising and alcohol consumption by underage youth and young adults who are of college age.xxvi For example, one study found that 12-year olds who are highly exposed to alcohol advertisements are 50 percent more likely to start drinking in a year’s time, compared to youth of the same age who have light exposure to alcohol advertisements.xxvii The methodologies of these studies have been criticized, and the authors of one study have acknowledged limitations in inferences which can be drawn because “unmeasured confounders cannot be adjusted for and can result in biased findings.”xxviii
In addition, the research consistently identifies the strong influence of parents and family environment with regard to young peoples’ drinking, as well as peer influence.xxix
Distinctions: Underage Possession vs. Consumption; On- vs. Off-Premise; ABV levels
Although possession and consumption are closely linked (as consumption requires possession), some jurisdictions distinguish between the two with regard to legal drinking age laws. In addition, some jurisdictions distinguish between possession and consumption in terms of exceptions made to legal drinking age laws.
In the United Kingdom, where the minimum legal age for purchasing alcohol is 18, minors are allowed to consume alcohol in the home from the age of five. In Australia, where the legal age for purchase and possession of beverage alcohol is also 18, children may consume alcohol in the home or under adult supervision at any age. In the U.S., approximately forty states have legislated provisions which specifically allow for consumption under the legal drinking age of 21 under certain circumstances—e.g., for religious reasons and/ or with parental approval.
In addition, certain jurisdictions make distinctions between the legal age limit for on-premise (e.g., pubs, bars, restaurants) versus off-premise (shops, stores, etc.) purchase of alcohol. As a result of such legal distinctions, as well as additional provisions about alcohol content, what is considered to be underage drinking can be a complex matter in some jurisdictions.
For example, in Austria, for distilled spirits, the minimum age for purchase and consumption is 16-years old in three of nine Federal States, and 18-years old in the six other Federal States (with some Federal States differentiating by alcohol content, legislating higher minimum ages for purchase or consumption of drinks with alcohol content of 12 percent Alcohol By Volume (ABV) or more). In Canada, the legal age for consumption or purchase is 18-years old in three provinces, but 19-years old in the remaining provinces. In India, on- and off-premise legal age limits range from 18 to 25, depending on the state. In Belgium, there is no minimum off-premise purchase age for wine and beer; in Brazil, there is no minimum off-premise purchase age for any kind of beverage alcohol.xxx For more information on such distinctions, see Appendix I and/or the related Issues Forum entry on Legal Drinking Age.
iInternational Center for Alcohol Policies, Blue Book, Module 11. See: http://www.icap.org/PolicyIssues/YoungPeoplesDrinking/tabid/131/Default.aspx.
iiInternational Center for Alcohol Policies, Blue Book, Module 11. See: http://www.icap.org/PolicyIssues/YoungPeoplesDrinking/tabid/131/Default.aspx.
iiiAraoz, G. (2004). Cultural Considerations. In What drives underage drinking? An international analysis. Washington, D.C: International Center for Alcohol Policies.
ivCurrie, C., Roberts, C., Morgan, A., Smith, R., Settertobutle, W., Samdal, O., et al. (Eds.). (2004). Young people’s health in context. Health Behaviour in School-aged Children (HBSC) study: International report from the 2001/2002 survey. Copenhagen, Denmark: WHO Regional Office for Europe.
vPopova, S., Rehm, J., Patra, J., Zatonski, W. (2006). Comparing alcohol consumption in Central and Eastern Europe to other European countries, Alcohol & Alcoholism, p.1. See: http://alcalc.oxfordjournals.org/cgi/content/full/agl124v2.
viThe Surgeon General’s call to Action To Prevent and Reduce Underage Drinking. See: http://www.surgeongeneral.gov/topics/underagedrinking/.
viiMonitoring the Future, National Results on Adolescent Drug Use (2009), National Institute on Drug Abuse, U.S, Department of Health and Human Services. See: http://www.monitoringthefuture.org/data/09data.html#2009data-drugs.
viiiUnderage Alcohol Use: Where Do Young People Get Alcohol? National Survey on Drug Use and Health Report (updated November 2008). See: http://www.oas.samhsa.gov/2k8/underageGetAlc/underageGetAlc.htm.
ixThe Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking. See: http://www.surgeongeneral.gov/topics/underagedrinking/.
xJ.W. Miller et al, Binge Drinking and Associated Health Risk Behaviors Among High School Students, 119 Pediatrics 76-85 (2007). See: www.pediatrics.org/cgi/content/fall/119/1/76.
xiOffice of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA), National Survey on Drug Use and Health, March 31, 2008. See: http://www.oas.samhsa.gov/2k8/underage/underage.cfm.
xiiGfk Roper Youth Report 2008, accessed at http://www.alcoholstats.com/page.aspx?id=135.
xiiiArata, C. M., Stafford, J., & Tims, M. S. (2003). High school drinking and its consequences. Adolescence, 38, 567–579.
xivGeckova, A., & van Dijk, J. P. (2001). Peer impact on smoking, alcohol consumption, drug use and sports activities in adolescents. Studia Psychologica, 43, 113–123.
xvEccles, J. S., & Barber, B. L. (1999). Student council, volunteering, basketball, or marching band: What kind of extracurricular involvement matters? Journal of Youth and Adolescence, 6, 281–294.
xviLeichliter, J. S., Meilman, P. W., Presley, C. A., & Cashin, J. R. (1998). Alcohol use and related consequences among students with varying levels of involvement in college athletics Journal of American College Health, 46, 257–262.
xviiDonovan, J. E., Leech, S. L., Zucker, R. A., Loveland-Cherry, C. J., Jester, J. M., Fitzgerald, H. E., et al. (2004). Really underage drinkers: Alcohol use among elementary students. Alcoholism: Clinical and Experimental Research, 28, 341–349.
xviiiWood, M. D., Read, J. P., Mitchell, R. E., & Brand, N. H. (2004). Do parents still matter? Parent and peer influences on alcohol involvement among recent high school graduates. Psychology of Addictive Behavior, 18, 19–30.
xixAlcoholism: Clinical & Experimental Research (2008, January 6). Children Are Introduced To Sipping and Tasting Alcohol In The Home. ScienceDaily. See: http://www.sciencedaily.com/releases/2008/01/080103161553.htm.
xxWood et al., 2004.
xxiSubstance Abuse and Mental Health Services Administration, June 26, 2008. For a summary and link to full report, see: http://www.samhsa.gov/newsroom/advisories/0806250013.aspx.
xxiiUnderage Alcohol Use: Where Do Young People Get Alcohol? National Survey on Drug Use and Health Report (November 2008). See: http://www.oas.samhsa.gov/2k8/underageGetAlc/underageGetAlc.htm.
xxiiiAlcohol Marketing and Young People, International Center for Alcohol Policies. See:http://icap.org/LinkClick.aspx?fileticket=EkpMOGhCHU8=&tabid=243.
xxivNational Institute on Alcohol Abuse and Alcoholism (NIAAA). (2000). Tenth special report to the U.S. Congress on alcohol and health. Washington, DC: U.S. Department of Health and Human Services.
xxvInternational Center for Alcohol Policies. See: http://icap.org/PolicyIssues/Marketing/KeyFactsandIssues/tabid/213/Default.aspx.
xxviAnderson, P., de Bruijn, A., Angus, K., Gordon, R., & Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. Alcohol and Alcoholism, 44, 229–243. Smith, L. A., & Foxcroft, D. R. (2009). The effect of alcohol advertising, marketing and portrayal on drinking behaviour in young people: Systematic review of prospective cohort studies. BMC Public Health, 9, 15.
xxviiCollins, R., Ellickson, P., McCaffrey, D., Hambarsoomians, K., 2007. Early adolescent
exposure to alcohol advertising and its relationship to underage drinking. Journal of
xxviiiAdequate controls for confounding variables are necessary to ensure validity of research results. See: http://www.stap.nl/eucam/home/smith__foxcroft_2007.html. For an overview analysis of the literatures, see: http://icap.org/LinkClick.aspx?fileticket=EkpMOGhCHU8=&tabid=243.
xxixEpstein, J. A., Griffin, K. W., & Botvin, G. J. (2008). A social Influence model of alcohol use for inner-city adolescents: Family drinking, perceived drinking norms, and perceived social benefits of drinking. Journal of Studies on Alcohol and Drugs, 69, 397–405. Scholte, R. H. J., Poelen, E. A., Willemsen, G., Boomsma, D. I., & Engels, R. C. (2008). Relative risks of adolescent and young adult alcohol use: The role of drinking fathers, mothers, siblings, and friends. Addictive Behaviors, 33, 1–14. van der Zwaluw, C. S., Scholte, R. H. J., Vermulst, A. A., Buitelaar, J. K., Verkes, R. J., & Engels, R. C. M. E. (2008). Parental problem drinking, parenting, and adolescent alcohol use. Journal of Behavioral Medicine, 31, 189–200.
xxxInternational Center for Alcohol Policies. See: http://www.icap.org/PolicyIssues/YoungPeoplesDrinking/AgeLawsTable/tabid/219/Default.aspx
Education and Targeted Prevention Initiatives
In efforts to prevent and stop underage drinking, programs have been developed and customized for various audiences, taking into account that influences such as parents, other family members, peers, educators, and role models contribute to young peoples’ choices about whether or not they decide to drink.i
Experts agree that parents talking with their children about drinking can play a key role in preventing the negative effects of underage drinking. For example, in the U.S., an ongoing public outreach campaign sponsored by SAMHSA, the Office of the Surgeon General, and the Ad Council encourages parents to speak with their children early and often about the negative effects of underage drinking, and offers tips for how to do so.ii
Also in the U.S., in addition to the Federal Trade Commission’s “We Don’t Serve Teens” public education initiative, the Century Council (www.centurycouncil.org) has developed a variety of initiatives ranging from Ask. Listen. Learn. (developed in conjunction with Nickelodeon for middle school-aged children), Alcohol 101 Plus (an interactive, online program designed to help college students make responsible decisions about alcohol), and Not in Our House (a nationwide initiative on underage drinking and social hosting).
Similarly, in the U.K., the Think-Don’t Drink public awareness campaign targets youth in that country and promotes messages about responsible decision-making with regard to alcohol and drinking behaviors.iii In Spain, an education program in schools which focuses on 12- to 16-year olds and their parents has been showing positive results, according to the Fundacion Alcohol y Sociedad. Between 2002 and 2006, the age at which teenagers report having their first drink increased from 13.9 to 14.50, and the percentage of underage drinkers decreased from 60.1 percent to 50.3 percent.iv
A number of interventions have proven to be successful in influencing the decisions that underage youth make about alcohol. Early identification of problem drinking, followed by brief interventions aimed at modifying behavior, can help minimize harm among individuals who are alcohol abusers but not dependent. Such programs range from social norms marketing (aimed at correcting peer misperceptions) to server training programs and life skills programs in schools and communities.v Examples of such programs from across Europe are summarized in the annual EFRD/CEPS brochure on alcohol industry initiatives developed to help reduce alcohol-related harm (at www.efrd.org). In addition, examples of such efforts in the United States can be found at www.mystrongfamily.com and www.talkaboutalcohol.com.
Responsible Marketing and Ad Placements
There are well-established industry codes for responsible marketing worldwide—codes which comprehensively address the importance of marketing and advertising practices which are directed to only consumers of legal drinking age. These codes include the Distilled Spirits Council of the United States (DISCUS) Code of Responsible Practices for Beverage Alcohol Advertising and Marketing and similar codes of responsibility established by The Beer Institute and The Wine Institute, the European Spirits Association (CEPS), the European Forum for Responsible Drinking (EFRD) Common Standards on Commercial Communications, the Distilled Spirits Industry Council of Australia (DSICA), the Brewers Association of Japan and the Japan Spirits & Liquors Makers Association, and the Portman Group in the United Kingdom.
Two key elements of such codes are industry standards for ad content as well as ad placement. Ad content standards include commitments similar to those found in the Brown-Forman Marketing, Advertising, and Promotional Policy, which specifies that:
Ads should not feature children, cartoon figures, or anything that appeals primarily to persons below the legal drinking age.
There should be no suggestion that alcohol use represents a “rite of passage” to adulthood.
There should be no suggestion that drinking alcohol is a means to attain success.
Models and actors employed must be a minimum of 25-years old, and appear to be at least 21-years old.
The industry standard in the U.S. for ad placements includes a key commitment to direct marketing to only adults of legal drinking age, and to advertise only in media with audiences that are at least 70 percent legal drinking age or older.vi (Brown-Forman has taken an additional step of planning our placements to deliver total cumulative impressions by brand and by media to average at least an 80 percent LDA audience. For more information, see http://www.brown-forman.com/responsibility/.)
There are criticisms of the self-regulation approach, most of which fall along the lines of “is the fox guarding the hen house?” To that point, in its third study on this topic in 2008, the FTC stated that “the current 70 percent baseline standard has helped to ensure that alcohol advertising is not disproportionately directed to those below the legal drinking age.” The report found that more than 97 percent of total alcohol advertising impressions among the 12 DISCUS member companies were in compliance with the 70 percent standard. The report also noted that all three segments of the alcohol industry (wine, beer, spirits) have adopted systems for third-party review of advertising complaints.vii
In Europe, based on a study initiated to measure industry compliance with its own self-regulation initiatives, the European Advertising Standards Alliance (EASA) recently reported a 95 percent compliance rate across 19 EU member states. (For more on this topic, see The Issues Forum entry on Self-Regulation and Responsible Marketing Code.)
The Strong Influence of Parents and Family
The majority of youth surveyed who report drinking say that they get the alcohol they drink from family and friends—from their parents, their friends' parents, older siblings or family members or older friends, with or without permission. As noted in the Research section of this Issues Brief, according to the 2008 Roper Youth Report, of the individuals between the ages of 8 and 17 surveyed in the U.S., 71 percent indentified their parents as the leading influence that might affect their decisions about drinking. Education and prevention programs such as the Century Council’s Ready or Not initiative stem from research results such as 97 percent of young people claiming they believe they have enough information to make the right decisions about drinking—yet half of the sixth through 12th graders surveyed reported drinking alcohol within the past month.x
iHoughton & Roche, 2001.
vFor a complete listing of targeted intervention examples worldwide, see: International Center for Alcohol Policies, Blue Book, Module 12. See: http://www.icap.org/Publication/ICAPBlueBook/tabid/148/Default.aspx.
viSince 2006, Brown-Forman media buying plans have been designed to deliver at least 80 percent of total impressions to those LDA and above. See: http://brown-forman.com/responsibility/. For more information generally, see the ICAP Report (#9) on Self-Regulation of Beverage Alcohol Advertising at http://www.icap.org/Publication/ICAPReports/tabid/147/Default.aspx.
viiSelf-Regulation in the Alcohol Industry: Report of the Federal Trade Commission (June 2008). See: http://www2.ftc.gov/opa/2008/06/alcoholrpt.shtm.
viiiSee: www.efrd.org. See also: http://www.foodanddrinkeurope.com/Products-Marketing/Report-claims-spirit-ad-responsibility-success.
ixGfk Roper Youth Report 2008, accessed at http://www.alcoholstats.com/page.aspx?id=135.